血管紧张素系统基因多态性与经皮冠状动脉腔内成形术加支架置入术后支架内再狭窄的关系

目的:心血管支架内再狭窄的好发因素很多,在探讨肾素-血管紧张素系统基因型与冠状动脉粥样硬化性心脏病患者经皮冠状动脉腔内成形术及支架置入术后支架内再狭窄相关性的基础上,进一步分析支架内再狭窄发生的其他相关因素。方法:选择2003-03/2004-12于复旦大学附属中山医院心血管内科接受经皮冠状动脉腔内成形术加支架置入术的上海籍汉族患者103例,有6个月随访造影资料并且临床资料完整,均知情同意。根据临床诊断标准,将患者分为再狭窄组(n=30)和未狭窄组(n=73)。再狭窄组30例,根据病例情况调查表,对患者的年龄、病史、实验室检查结果、狭窄病情、经皮冠状动脉腔内成形术和支架相关因素等进行综合分析,对患者冠状动脉狭窄情况、血管紧张素Ⅰ转换酶、血管紧张素原(M235T)和血管紧张素Ⅱ受体1(A1166C)基因型与支架内再狭窄的关系进行多元Logistic回归分析。结果:①103例患者全部进入结果分析,经皮冠状动脉腔内成形术加支架置入术后支架内再狭窄发生率为29.19%。②再狭窄组患者多支狭窄发生率大于未狭窄组(χ2=14.203,P=0.000)。③血压、血脂、支架个数、安放次数、安放位置等因素、支架置入前经皮冠状动脉腔内成形术的次数、扩张程度、是否更换球囊或更换球囊种类与术后是否发生支架内再狭窄无关(P>0.05)。④血管紧张素Ⅰ转换酶(D/I)与支架内再狭窄具有相关性(P<0.05)。结论:经皮冠状动脉腔内成形术加支架置入术患者的血管紧张素Ⅰ转换酶(D/I)基因型和冠状动脉多支狭窄与支架内再狭窄存在关联。     

Prevalence of diabetes,impaired fasting glucose and insulin resistance syndrome in an urban Indian population

OBJECTIVE: Epidemiological study among urban subjects in western India to determine prevalence of diabetes, insulin resistance syndrome (IRS) and their risk factors. METHODS: Randomly selected adults > or =20 years were studied using stratified sampling. Target sample was 1,800 (men 960, women 840). 1123 subjects (response 62.4%) were evaluated and blood samples were available in 532 men and 559 women (n=1091, 60.6%). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Atherosclerosis risk factors were determined using current guidelines. Diabetes was diagnosed when the subject was a known diabetic or fasting blood glucose was > or =126 mg/dl, impaired fasting glucose (IFG) diagnosed when fasting glucose was 110-125 mg/dl. IRS was diagnosed when any three of-IFG, high triglycerides >150 mg/dl, low HDL cholesterol (men<40 mg/dl, women<50 mg/dl), central obesity (men>102 cm, women>88 cm), or high normal blood pressure (>130/>85 mmHg) or hypertension-were present. RESULTS: Diabetes was present in 70 men (13.2%) and 64 women (11.5%). Age-adjusted prevalence of diabetes was 9.3% in men (95% confidence intervals (CI) 6.7-11.8), 8.1% in women (CI 5.8-10.4) and 8.6% overall (CI 6.9-10.3). IFG was in 28 men (5.3%) and 29 women (5.2%). IRS was present in 52 men (9.8%) and 114 women (20.4%) with age-adjusted prevalence of 7.9% in men (CI 6.7-9.1) and 17.5% in women (CI 14.4-20.6) with an overall prevalence of 12.8% (CI 10.8-14.8). Other metabolic abnormalities of IRS in men and women were high triglycerides in 32.1 and 28.6%, low HDL cholesterol in 54.9 and 90.2%; central obesity in 21.8 and 44.0%, and high normal blood pressure or hypertension in 35.5 and 32.4%. IFG subjects had similar atherosclerosis risk factor profile as normal subjects while those with IRS and diabetes had significantly greater prevalence of obesity, central obesity, hypertension, high triglycerides and low HDL (P<0.01). CONCLUSIONS: There is s significant prevalence of diabetes and IRS in this urban Indian population. Subjects with diabetes as well as IRS have greater prevalence of obesity, central obesity, hypertension, hypertriglyceridemia and low HDL as compared with normal subjects.     

Medium-term outcome of anatomically repaired congenitally corrected transposition: the double switch operation

BACKGROUND: The double switch operation is emerging as the procedure of choice for congenitally corrected transposition of the great arteries. However, rhythm disturbances in the postoperative period are rarely discussed. METHODS AND RESULTS: Eighteen survivors who underwent corrective surgery for congenitally corrected transposition of the great arteries were followed up. Patients in group I (n=8), who also had a ventricular septal defect and pulmonary stenosis, had undergone the Senning plus Rastelli operation. Patients in group II (n=10), who did not have pulmonary stenosis, had undergone the Senning and arterial switch operation. The patients were followed up by periodical clinical examination, echocardiography and 24-hour Holter monitoring. In group I, follow-up ranged from 24 to 66 months (mean 44 months). There was no late death and all the patients are symptom free. There was no significant atrioventricular valve regurgitation and left ventricular function was normal. There were no rhythm disturbances. In group II, follow-up ranged from 2 to 72 months (mean 48 months). There were 2 late deaths due to atrial tachyarrhythmia and residual pulmonary hypertension 36 and 8 months after the procedure, respectively. One patient had significant mitral regurgitation and required mitral valve replacement. Three patients had recurrent atrial/junctional tachyarrhythmia: one of them was lost to follow-up after 1 year while another died of resistant atrial tachyarrhythmia. The third patient underwent mitral valve replacement for severe mitral regurgitation and developed complete heart block necessitating a permanent pacemaker implantation. CONCLUSIONS: Though good long-term results are obtained following the double switch operation, the problem of atrial arrhythmias still needs to be addressed suitably.     

Population pharmacokinetic modeling for dose setting of nonacog beta pegol (N9‐GP), a glycoPEGylated recombinant factor IX

Summary. Background: nonacog beta pegol (N9‐GP) is a glycoPEGylated recombinant factor IX (rFIX) molecule with a prolonged half‐life. Objectives: To provide information on potential dose regimens for N9‐GP for phase 3 pivotal and surgery trials. Methods: A population pharmacokinetic model was developed from single‐dose data derived from the first human‐dose trial with N9‐GP in hemophilia B patients, and was used to extrapolate to steady‐state conditions for different N9‐GP dose regimens for prophylaxis. The model was also used to compare prophylaxis using N9‐GP with standard prophylactic regimens using rFIX or plasma‐derived (pd) FIX (40 IU kg^?1 every third day). Plasma activity following dosing with N9‐GP, rFIX and pdFIX for surgery and on‐demand treatment of bleeds was also simulated. Results: A linear two‐compartmental model best described the pharmacokinetic profiles of N9‐GP, rFIX and pdFIX. A prophylactic regimen of 10 U kg^?1 N9‐GP once weekly predicted mean peak and trough levels of 18 and 4.2 U dL^?1, while 40 U kg^?1 once weekly predicted values of 72 and 17 U dL^?1, respectively. Standard prophylactic regimens with rFIX and pdFIX predicted mean peak and trough levels of 34 and 3.9 IU dL^?1 for rFIX, and mean values of 43 and 2.1 IU dL^?1 for pdFIX. Additional simulations predicted significantly reduced dosing frequency and factor concentrate consumption for N9‐GP vs. rFIX and pdFIX for surgery and the treatment of bleeds. Conclusions: N9‐GP may allow prophylaxis, surgical dosing regimens and on‐demand treatment of bleeding episodes with less frequent injections and lower factor concentrate consumption; this possibility is being investigated in prospective clinical trials.     

False-positive human immunodeficiency virus type 1 western blot tests in noninfected blood donors

Background: The manufacturers' criteria for a positive human immunodeficiency virus type 1 (HIV-1) Western blot (WB) test were recently revised to require reactivity to only two of the following bands: p24, gp41, and gp120/160. In a recent report, low-risk blood donors were identified in whom nonspecific reactivity to multiple env antigens in WB testing resulted in apparently false-positive WBs by these criteria. The present study was conducted to verify the existence of false-positive WBs among noninfected donors and to assess the extent of this problem. Study Design and Methods: Four donors classified as WB- positive on the basis of env-only (3 cases) or p24/env-only (1 case) patterns were investigated. Index and/or follow-up specimens were tested by polymerase chain reaction (PCR), by overlapping recombinant env antigens and synthetic peptides in enzyme immunoassays, and by deglycosylated and denatured antigen WBs. WB records from American Red Cross blood centers were reviewed to determine the frequency of env- only and p24/env-only patterns, relative to all positive WBs, from 1988 through 1993. Results: The four index-case donors denied risk and had stable WB reactivity during follow-up. HIV PCR was negative in all. Env reactivity was restricted to nonglycosylated gp41 epitopes; no gp120- specific reactivity was detected. For three of the four donors, env reactivity was mapped to a 20-amino acid N-terminal epitope of gp41. The rate of detecting WBs with these false-positive patterns increased from 0.6 percent of all positive WBs from 1988 to 1990 (4/776) to 8 percent in 1991 and 1992 (52/683), and then it declined to 6 percent in 1992 and 1993 (47/783). Env-only patterns predominated in 1991 and 1992, whereas p24/env-only patterns were more frequent following implementation of combined anti-HIV-1/HIV type 2 enzyme immunoassays in 1992. Conclusion: Low-risk blood donors can have false-positive results on WB tests. Increased detection of env-only and p24/env-only WBs appears related to the enhanced sensitivity of newer enzyme immunoassays to gp41 and p24 antibodies. Donors with these patterns should undergo follow-up testing to document the presence or absence of HIV infection.     

Mixed variety of total anomalous pulmonary venous connection: diagnosis by 2D echocardiography and Doppler colour flow imaging.

Of the many types of total anomalous pulmonary venous connection, mixed type is the least common. Its accurate non-invasive diagnosis by echocardiography poses a diagnostic challenge. We report our experience of echocardiography in 21 infants with mixed type of total anomalous pulmonary venous connection aged 25 days to one and half years. Multiple windows were used to identify individual pulmonary veins and various sites of drainage. Cardiac catheterisation and angiography were performed for 17 cases. In 11 of 21 cases, the left upper pulmonary vein was seen draining into vertical vein and the left lower and right-sided pulmonary veins were draining into the coronary sinus. Cardiac and supracardiac combinations of other types were seen in eight more cases. Both drainage sites were supracardiac in one case and supracardiac and infracardiac in another. On comparing echocardiographic findings with those obtained at cardiac catheterisation and/or surgery (carried out in 18 cases), there were three instances of error. In two cases (echocardiography performed without the use of colour flow imaging) the second site of drainage could not be defined. These patients were catheterised as all four pulmonary veins were not delineated by echo. The third error occurred in a case where although two sites of drainage were picked up by echo but at surgery, the right lower pulmonary vein was noted to have a double connection, both to coronary sinus and to vertical vein. We conclude that mixed type of total anomalous pulmonary venous connection can be accurately diagnosed by echocardiography and Doppler colour flow imaging. The diagnostic errors are rare and would not alter the surgical management.     

Skin lesion in a patient with acute myeloid leukemia

We present the case of a 51‐year‐old man with acute myeloid leukemia who developed fevers with a skin lesion following the first cycle of induction chemotherapy. Skin biopsy showed evidence of invasive fungal infection. Cultures remained negative, but polymerase chain reaction on tissue detected Rhizopus oryzae complex. The patient was started on liposomal amphotericin B and underwent surgical debridement. He was switched to posaconazole, with plans for allogeneic hematopoetic stem cell transplant in the future.     

Prognostic implication of early posttransplant hypercholesterolemia in liver transplantation for patients with hepatocellular carcinoma

Background: Hyperlipidemia is a common complication after liver transplantation(LT) and develops mostly in the early posttransplant period. Recently, some studies have reported a positive correlation between hyperlipidemia and favorable prognosis in patients with hepatocellular carcinoma(HCC) undergoing hepatectomy. This study aimed to evaluate the possibility of predicting prognosis in HCC patients receiving LT by early posttransplant dyslipidemia. Methods: From January 2015 to December 2017, a...